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Teen Challenge of Florida, Inc.

Organization Active NPI Professional Counselor · Sebree, KY

NPI 1366486680 · NPPES record last updated Jan 25, 2021

Key facts

NPI
1366486680
Entity type
Organization (NPI type 2)
Primary specialty
Professional Counselor 101YP2500X
Legal business name
TEEN CHALLENGE OF FLORIDA, INC.
Practice address
25 W Webster St
Sebree, KY 42455
Phone
(484) 868-0584
NPI assigned
Jun 16, 2006
Organization subpart
No

Authorized official

Name
Mr. Brice Maddock
Title
Ceo
Phone
(706) 596-8731

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2167612Teen Challenge of Florida, Inc
15 W 10TH Street, Columbus, GA 31901		Certificate of waiverJun 11, 2027

National Provider Directory

Tax ID family
Ozarks Teen Challenge (2 organizations share this tax ID)

Locations

3706 S Sanford Ave
Sanford, FL 32773
Phone 4073309600 ext. 305

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor
Group: 193200000X MULTI-SPECIALTY GROUP		 101YP2500X Yes
Community/Behavioral Health Agency 251S00000X
Adult Mental Health Clinic/Center 261QM0850X
Substance Abuse Rehabilitation Facility 324500000X 0759AD922801 FL

Addresses

Primary practice location

25 W Webster St
Sebree, KY 42455

Mailing address

15 W 10TH St
Columbus, GA 31901-2744
Phone (706) 596-8731

Other practice location 1

3706 S Sanford Ave
Sanford, FL 32773-6002
Phone (407) 330-9600 ext. 305

Other practice location 2

15 W 10th St
Columbus, GA 31901-2744
Phone (706) 596-8731

Other providers in Sebree, KY

All providers in Sebree, KY · Professional Counselor in Kentucky

Sources for this page

Verify at the official NPI Registry.